MARION — There was a sizable dent in opioid prescribing to Marion County residents last year, but the county still trails far behind the rest of Ohio in reducing prescription painkiller numbers, according to the Ohio Board of Pharmacy's latest data.

In 2018, Ohio saw the largest year-over-year decline in opioid dispensing since the epidemic began. Marion County was no exception.

Last year, Marion County residents filled prescriptions for about 4.53 million opioid pills, or nearly 470,000 less than in 2017, according to the data. That's a 9 percent drop in the number of opioid pills, the biggest year-over-year decline for Marion County residents since a 2013 peak of 5.35 million pills, the data show.

Health care professionals and public officials have been trying to bring those numbers down, with many opioid addicts citing a prescription for painkillers as the gateway to addiction.

But Marion County's numbers have fallen at the slowest rate out of any Ohio county since the epidemic's peak, and 2018 was no different. The county is about 10 percentage points behind the next slowest county.

"It is not going down as much as it is in other places," said Brad DeCamp, executive director of the Marion-Crawford Board of Alcohol, Drug Addiction and Mental Health Services.

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In Ohio as a whole, opioid dispensing to Ohio patients has declined by 41 percent since it peaked in 2012.

By comparison, in Marion County, the decline has been 15 percent since its 2013 peak. The county with the next lowest rate, Clark County, saw a decline of nearly 25 percent since 2013.

Marion County residents now fill prescriptions for the fourth highest number of opioids per capita, behind Adams, Vinton and Perry counties. Marion County has climbed that list every year since 2012.

In 2018, there were enough opioid pills dispensed to Marion County residents for every man, woman and child living in the county to have 68 pills, according to the pharmacy data. That is compared to nearly 78 pills per capita in Adams County, 69 in Vinton County and 69 in Perry County. In Delaware County, the rate is 30 pills per capita, and in Franklin County, it is about 39.

Marion County does not want to be near the top of that list, DeCamp acknowledged.

DeCamp said that he and other local stakeholders intend to reach out to the state for help in understanding why Marion's numbers have declined so little when compared with the rest of the state.

"We probably need to get the state a little bit more involved and say, 'Are there any more assets that you can lend us?'" he said.

The Ohio Board of Pharmacy's prescription monitoring program collects reams of data on outpatient prescribing of opioids and other controlled substances.

OhioHealth officials have said it is unclear why the number of opioids dispensed to Marion County residents have been slow to decline.

"We have ... governance committees and peer review processes and clinical guidance councils that help to drive standardization of clinical care wherever it's appropriate and possible," said Dr. Mrunal Shah, vice president of medical affairs at OhioHealth Marion General Hospital.

Dr. David Applegate, vice president of medical affairs with the OhioHealth Physician Group, said that the physician group monitors its physicians' prescribing habits and trends through monthly reviews.

"We have educational meetings and conversations with doctors who appear to be outliers or we try to ask questions learning how that happens," he said.

'Still too high'

While there has been progress in drawing down the opioid supply, the numbers are "still too high," said Ernie Boyd, executive director of the Ohio Pharmacists Association.

"When I think back to 30 years ago when I was dispensing, we had nowhere near this per capita (rate), and we didn't have people running around screaming in pain," he said.

"They really kind of cracked down on the number of tablets that physicians and other prescribers were prescribing," he said.

Under rules that went into effect in late August 2017, no more than seven days of opioids can be prescribed to adults with acute pain, unless the physician or other prescriber gives a specific reason for a longer prescription in the patient's medical record. The new rules also placed limits on dosages of opioids for acute pain patients.

Boyd said that some prescribers are turning to over-the-counter alternatives that have proven as effective, if not more effective, than prescription painkillers.

He said that many dentists and oral surgeons have turned to using a combination of acetaminophen, more commonly known as Tylenol, and ibuprofen to treat patients' pain. However, he cautioned that it didn't mean that combination would necessarily be as effective on other types of pain.

In Marion, the Drug Free Marion coalition is working to promote opioid-related education for both health care professionals and patients.

The coalition is planning an educational event on May 8 for health care professionals that will touch on addiction, medication assisted treatment and prescribing practices, DeCamp said.

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Reducing prescriptions 'still important'

Law enforcement and probation officers in Marion and across the state have noted a resurgence of methamphetamine and other non-opioid drug use in communities.

Even taking into consideration shifts in drug use, Boyd and others say it is still important to drive down opioid prescribing.

"The prescribing piece is important because virtually no folks go out and say, 'Hey, do you know a drug dealer?' They get addicted through whatever means, and then is when they start banging the door looking for the illegitimate stuff," he said.

Cameron McNamee, the Ohio Board of Pharmacy's director of policy and communications, agreed.

He said that reducing people's exposure to highly addictive opioids is "critical" to preventing addiction.

"It very much begins kind of insidiously with you have a lower back problem or you broke your arm," he said. "Opioids are still the No. 1 driver of deaths in the state, and it’s irrefutable that most people get started through the health care system."

The counties with the lowest number of opioids dispensed per capita were Ashland County with nearly 25 tablets per person, Geauga County with about 24 per person and Holmes County with about 12 tablets per person, according to the Board of Pharmacy data.

svolpenhei@gannett.com

740-375-5155

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